1. The Field of the Invention
Broadly conceived, the present invention relates to surgical probe devices or wands employed in the field of endoscopic surgery. More particularly, the present invention relates to an endoscopic probe that performs multiple functions, including electro-surgical cut and cautery, two modes of irrigation, suction, and rotational positioning of the electro-surgical tip.
2. The Background of the Invention
In medical practice, electro-coagulation involves the application of a highly concentrated heat source, usually from a heated metallic instrument, to cut and cauterize tissue during a surgical procedure. As opposed to the cold steel of a standard surgical knife, the heated blade of an electro-coagulation instrument quickly and efficiently cuts through tissue while simultaneously cauterizing the exposed layers. The cauterization process seals the exposed tissue surfaces and prevents loss of blood through bleeding.
To achieve the cut and cauterization of the intimal tissue at the surgical site, there are two electrocautery devices commonly used in the art. The bipolar electrocautery device has a two pronged tip configuration with a high electric potential drawn between the two prongs of the bipolar cautery tip. When the surgeon directs the tip over tissue, the electric current passes through the tissue between the two prongs and is simultaneously cut and cauterized. The unipolar electrocautery device makes use of a single prong at the tip. An electric pad is placed underneath the patient's buttocks or thigh. When the surgeon places the unipolar cautery tip to contact the patient's tissue, the electric current is focused at the point where the tip meets the tissue such that the tissue gets simultaneously cut and cauterized.
Electro-cauterization techniques are typically performed after an incision is made through the patient's skin in order to expose the underlying operative area. For quite a number of surgical procedures, the incision made through the patient's skin is relatively large in order for the surgeon to expose a large enough section of the operative area such that the surgeon's hands and instruments can reach the surgical site. One problem with the requirement of a large incision through the patient's skin is increased trauma and longer recuperative periods for the patient. The result is increased hospital stays and related post-operative costs, and increased risk of complications.
In order to reduce the size of the incision made through the patient's skin, advances have been made in basic surgical procedures and related technologies. One procedure, known as endoscopy, has rapidly developed in the surgical arts as a preferred methodology for performing certain surgical procedures without having to make large incisions in the patient. Endoscopic procedures involve introducing one or more trocars through puncture wounds in the patient and then accessing the internal surgical site using instruments introduced through the trocars, and using an endoscope to view the operative site as the surgical procedure is performed.
An example of one such endoscopic procedure is laparoscopic cholecystectomy, which is now a preferred surgical modality for the treatment of gallstone disease. This procedure employs a high-resolution video endoscopy system with color monitors and a light source, a high-flow CO.sub.2 insufflator, an endoscopic suction-irrigation system, and an electrocautery device to enable the surgeon to completely remove the gallbladder without the need for one or more relatively large incisions through the patient's abdominal wall. Further, the surgeon's hands do not enter the abdominal peritoneal cavity.
To initiate a laparoscopic cholecystectomy procedure, the surgeon inserts four trocar devices into the patient through four small puncture wounds. The inside diameter of the bore of each trocar device is typically either 5 mm or 10 mm, depending on the instrumentation that is to be placed down the bore. The surgeon will place down one trocar tiny instrumentation such as a CO.sub.2 insufflator to distend the abdominal cavity with gas pressure. Another trocar will contain combined irrigation and suction equipment. A miniaturized camera and lighting equipment will be inserted down another trocar so that the operative area can be completely viewed from a color monitor placed nearby. Lastly, the surgeon will perform the cut and cautery portion of the surgical procedure through a fourth trocar using an electrocautery probe device.
The beneficial result of such endoscopic procedures is a decrease in overall morbidity rates otherwise inherent in such invasive surgical procedures. Since the patient has to recover from only four relatively small puncture wounds, the overall time of the hospital stay and the associated recuperative period is substantially minimized, resulting in decreased costs. In addition, the necessity for follow-up procedures is dramatically reduced, there is less risk of post-operative complications, and the patient can return to normal activity much more quickly.
Despite the benefits inherent in endoscopic procedures, disadvantages exist in the prior art as well. For example, when using a trocar the surgeon must repeatedly change instruments. This means removal of one device from within the trocar bore after a certain function is performed by that the same trocar in order to perform another specific function. One problem associated with the constant removal and insertion of various instrumentation is increased risk of infection of the internal organs and tissue of the patient. Another problem associated with the need to constantly insert and remove a series of different devices in order to perform the desired functions is that the overall procedure takes longer and is more complicated. Further, because the time duration for the entire procedure is lengthened, the patient is under the effects of anesthesia longer. The overall costs of the operation increase accordingly with the increase in complexity of the procedure and the increase in the time duration which the surgeon must devote to complete the surgical procedure.